Healthcare Provider Details

I. General information

NPI: 1639717481
Provider Name (Legal Business Name): NARINE BLEU GEVORKIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E HIGHLAND AVE
SAN BERNARDINO CA
92404-4614
US

IV. Provider business mailing address

1540 E HIGHLAND AVE
SAN BERNARDINO CA
92404-4614
US

V. Phone/Fax

Practice location:
  • Phone: 908-886-4981
  • Fax:
Mailing address:
  • Phone: 908-886-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: